Endothelial function and cardiovascular risk in active inflammatory bowel diseases

Abstract

Background: Endothelial dysfunction has been already reported in inflammatory bowel diseases (IBD). However, case series so far examined were rather heterogeneous as for disease severity and subsets investigated.

Objective: We evaluated endothelial dysfunction by brachial artery flow-mediated vasodilatation (FMD), and subclinical atherosclerosis by assessment of common carotid intima-media thickness (CCA-IMT) in a cohort of patients with Crohn's disease (CD) or Ulcerative colitis (UC) in active phase compared to healthy control subjects.

Methods: Forty-nine patients (mean age 41±16 years), 25 with CD and 23 with UC, and forty controls (mean age 45±15 years) were enrolled. Diagnosis was based on the standard clinical, endoscopic and histological criteria. Disease activity was assessed by Crohn's Disease Activity Index or Disease Activity Index. All patients, were under medical treatment as appropriate.

Results: FMD values were lower in IBD patients than controls (6.1±3.0 vs 8.2±3.4. p=0.003); no difference was seen between UC/CD groups (5.9±3.5 vs 6.3±2.6, p=0.67). No changes in statistical differences occurred after adjustment for age, gender, body mass index and family history of cardiovascular disease. Finally, no differences in IMT values were seen between IBD patients and controls. Disease duration and medical treatment did not affect endothelial function.

Conclusions: Our study showed a lower FMD in IBD patients. Inflammation and immune response could explain endothelial dysfunction, which is the earliest stage of atherosclerotic process. IBD patients in active phase might therefore be at higher risk for atherosclerosis progression.

Keywords: CCA-IMT; CD; CICs; CVD; Cardiovascular risk; Common carotid artery intima-media thickness; Crohn's disease; Endothelial function; FMD; Flow-mediated vasodilatation; IBD; IMT; Inflammatory bowel diseases; NO; UC; Ulcerative colitis; cardiovascular diseases; chronic inflammatory conditions; common carotid intima-media thickness; eNOS; flow-mediated dilatation; inflammatory bowel diseases; intima-media thickness; nitric oxide; nitric synthase.